Intraoperative ICG plasma disappearance rate helps to predict absence of early postoperative complications after orthotopic liver transplantation

• Published in: Journal of clinical monitoring and computing Vol. 27; no. 5; pp. 591 - 598
• Main Authors: Vos, J. J., Scheeren, T. W. L., Lukes, D. J., de Boer, M. T., Hendriks, H. G. D., Wietasch, J. K. G.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.10.2013; Springer Nature B.V
• Subjects: Algorithms; Anesthesiology; Assessments; Blood Chemical Analysis - methods; Critical Care Medicine; Diagnostic systems; Early Diagnosis; Graft Rejection - blood; Graft Rejection - diagnosis; Graft Rejection - etiology; Health Sciences; Humans; Indocyanine Green - analysis; Intensive; Liver; Liver Transplantation - adverse effects; Mathematical analysis; Mathematical models; Medicine; Medicine & Public Health; Metabolic Clearance Rate; Monitoring, Intraoperative - methods; Original Research; Patients; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Statistics for Life Sciences; Surgery; Transplantation; Early graft dysfunction; Point-of-care method; ICG; OLT; Indicator dilution technique
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-013-9474-1

Early postoperative complications after orthotopic liver transplantation (OLT) are a common problem in intensive care medicine. Adequate assessment of initial graft function remains difficult, however, plasma disaperance rate of indocyanine green (PDR ICG ) may have an additional diagnostic and prognostic value in this setting. We retrospectively evaluated the ability of intraoperative PDR ICG values to predict absence of early postoperative complications in 62 subjects. PDR ICG was measured non-invasively by pulse dye densitometry during surgery and was correlated with initial graft function. At the end of surgery, PDR ICG was higher in patients without complications: 24.9 % min −1 (n = 40) versus 21.0 % min −1 , (n = 22; p  = 0.034). An area under the ROC curve (AUROC) for PDR ICG was 0.70, while the AUROC for pH, lactate and PT at ICU admission were 0.53, 0.50 and 0.46, respectively. The AUROC of serum bilirubin and PT at postoperative day 5 were 0.68 and 0.49, respectively. The optimal cut-off PDR ICG value for predicting absence of development early postoperative complications was determined to be 23.5 % min −1 with 72.4 % sensitivity and 71.0 % specificity. Intraoperative point-of-care PDR ICG measurement during OLT already predicts absence of early postoperative complications, better and earlier than clinically used laboratory parameters.